REDESIGNING HOSPITAL WORKFLOW TO INCLUDE FAMILY CAREGIVERS OF PEOPLE LIVING WITH DEMENTIA

Abstract Family caregivers of hospitalized people living with dementia (PLWD) report feeling unprepared to fulfill caregiving tasks post hospitalization. Currently, clinicians lack guidance on how to include caregivers in hospital care. This descriptive study used a systems-engineering approach to identify optimal hospital workflows for caregiver inclusion. We conducted 28 hours of direct observations in a large academic hospital with field notes and audio-recorded three hours of interdisciplinary team debriefing meetings. Data analysis was guided by a work system model to map caregiver inclusion workflows using Lucidchart software and identify system barriers and facilitators to caregiver inclusion within each workflow. Results produced workflows of optimal practices for caregiver inclusion during admission, stay, and discharge. Workflow facilitators included healthcare clinicians’ willingness/ability to answer questions, caregiver advocacy skills, and presence of medical record fields focused on patient/family education. Barriers included inconsistent documentation, under-utilization of hospital common spaces, and using a passive approach to caregiver inclusion. Comparison of current practices to desired workflows for caregiver hospital inclusion can provide clinicians guidance on how to identify, assess, and educate caregivers. Future research should determine workflow acceptability and effectiveness for improving caregiver preparedness.

This study investigated the potential for implementation of the RESCUE stroke caregiver telehealth intervention by assessing acceptability, feasibility, and cost.Family caregivers (n=174) of Veteran stroke survivors from eight medical centers were randomized to usual care or intervention.The RN-led intervention involved discharge plan review, problem-solving training, education, and support delivered via one telephone session and eight asynchronous online messaging center sessions.Acceptability was assessed using an adapted Acceptability and Enactment Survey (n=42) and qualitative interviews with a subsample of caregivers (n=16).We used retention data to assess feasibility and calculated cost per participant.Findings indicate the intervention was acceptable to caregivers.Most intervention completers found the intervention very/extremely helpful (90.5%), very/ extremely easy to use (78.4%), and resolved most/all caregiving problems (64.3%).Qualitative interviews showed caregivers valued the asynchronous delivery method, personalized nature of the intervention, and ability of the RN to answer medical questions and provide education.More intervention caregivers dropped out compared to usual care (50.0%vs.19.3%, p< 0.001).Intervention dropout was predicted by lower education (p=0.03) and less positive views of caregiving (p=0.01).Cost was $309.98 per intervention completer.Findings support intervention acceptability and highlight the value of RN-led interventions.The relatively low cost and fully remote nature of the intervention support its suitability for widespread implementation.Multiple delivery options and flexible intervention schedules may enhance engagement.The RESCUE intervention provides a model of a low-cost post-discharge telehealth intervention for stroke caregivers that can be adapted for other conditions.Future work should test methods to augment retention.

DO PUBLIC HOME CARE CLIENTS "LOSE OUT ON SERVICES" BECAUSE THEY HAVE A FAMILY CAREGIVER?
Janice Keefe 1 , Lori Mitchell 2 , Jeff Poss 3 , and Jasmine Mah 4 , 1. Mount Saint Vincent University,Halifax,Nova Scotia,Canada,2. Shared Health Manitoba,Winnipeg,Manitoba,Canada,3. University of Waterloo,Waterloo,Ontario,Canada,4. Dalhousie University,Halifax,Nova Scotia,Can ada The public home care (PHC) system in Canada is heavily reliant on family caregivers to enable clients to stay in the community.When caregivers are present, there are concerns formal home care aide (HCA) services are less available.Using data from the Resident Assessment Instrument for Home Care (RAI-HC), we examined caregiver and client characteristics in relation to HCA service amounts.Our cohorts were individuals aged 60+ receiving an initial RAI-HC assessment in 2011-2013, and one subsequent assessment in two provincial jurisdictions: the Winnipeg Regional Health Authority (n=5,251) and Nova Scotia Health (n=5291).We measured weekly HCA hours and constructed a predictive model for hours of care controlling for client need.To identify the most underserved client population, we calculated the ratio between predicted to actual received hours of care ascertaining the lowest client quintile.In both jurisdictions, the odds of being underserviced were higher when the client co-resided or had a spouse.Clients living alone at initial intake were least likely to be underserved.Caregiver characteristics increasing the risk of being underserved in Winnipeg included providing IADLs/ADLs support, caring more than 14 hours per week and being unable to continue.Rurality increased risk of underservice in Nova Scotia.These findings contribute to the debate: is PHC a supplement or substitution for family care?PHC as a supplement to family care was more pronounced in Winnipeg and in rural Nova Scotia.Implications for greater equity across regions is explored using an Equity, Diversity and Inclusion lens.

United States, 3. Indiana University School of Public Health-Bloomington, Bloomington, Indiana, United States
Family caregivers of hospitalized people living with dementia (PLWD) report feeling unprepared to fulfill caregiving tasks post hospitalization.Currently, clinicians lack guidance on how to include caregivers in hospital care.This descriptive study used a systems-engineering approach to identify optimal hospital workflows for caregiver inclusion.We conducted 28 hours of direct observations in a large academic hospital with field notes and audio-recorded three hours of interdisciplinary team debriefing meetings.Data analysis was guided by a work system model to map caregiver inclusion workflows using Lucidchart software and identify system barriers and facilitators to caregiver inclusion within each workflow.Results produced workflows of optimal practices for caregiver inclusion during admission, stay, and discharge.Workflow facilitators included healthcare clinicians' willingness/ability to answer questions, caregiver advocacy skills, and presence of medical record fields focused on patient/ family education.Barriers included inconsistent documentation, under-utilization of hospital common spaces, and using a passive approach to caregiver inclusion.Comparison of current practices to desired workflows for caregiver hospital inclusion can provide clinicians guidance on how to identify, assess, and educate caregivers.Future research should determine workflow acceptability and effectiveness for improving caregiver preparedness.

THE EFFECTS OF PARTNERS' HAPPINESS ON EACH OTHER: AN ACTOR-PARTNER INTERDEPENDENCE MODEL Elnaz Abaei, and Peter Martin, Iowa State University, Ames, Iowa, United States
The study of happiness among older adults has attracted the attention of researchers and practitioners.Happiness is affected by multiple factors, including the relationship with a partner, as they spend more time together in later life.This research aims to evaluate an actor-partner interdependence model, assessing the association of respondent and spouse happiness affecting each other over time.A second aim is to examine the effect of age, gender, education, and whether parents are alive on the respondents' and their spouses' happiness.About 9,570 individuals over 50 years of age from the Health and Retirement Study (HRS) and their spouses were included.Respondents' and their spouses' happiness measured at two time points were included in the analysis, as were age, gender, education, and the parents' living status.Multiple regression analyses in SPSS were computed, and the results demonstrated that past happiness is directly associated with present happiness for both respondents and spouses.Respondents' happiness was also significantly associated with spouses' happiness, as spouses' happiness was associated with respondents' happiness.Furthermore, older age, male gender, and higher education were associated with happiness.Parents' living status was significantly related only to respondents' happiness at the first time point, but not to spouses' happiness.This study helps to understand an actor-partner interdependence model, which highlights partners' influences on each other's subjective well-being.Our exploratory study raises several opportunities for future research regarding the actor-partner interdependence model.More research will be necessary to find further variables affecting happiness among older adults.The study is grounded in three core objectives: distinguishing senior consumers from other age groups, distinguishing therapeutic and recreational use, and distinguishing life-time and naive cannabis consumers.With the support of the National Cancer Institute, Fahey conducts a cross-sectional study on consumption patterns of cancer patients over the age of 65, analyzing patient reported outcomes of symptom management through cannabis.Finally, Bluthenthal and Cohen perform quantitative, health surveys among 429 communityrecruited people who inject drugs (PWID) to understand the potential benefit of a legal cannabis as a substitution for criminalized substances and alcohol.The papers in this symposium provide updated insights into widespread cannabis use among older adults.These findings may help forward conversations about the political and clinical changes that must be made in order to protect the therapeutic needs of older adults amidst a rapidly expanding cannabis industry.

PATTERNS OF MARIJUANA USE IN THE US OLDER ADULT POPULATION Jennifer Ailshire, University of Southern California, Los Angeles, California, United States
Marijuana use is increasing in the U.S. population, including among adults 50 and older, but research on population characteristics of marijuana use in middle aged and older adults is limited.We use data from the 2018-2021 Behavioral Risk Factor Surveillance System (BRFSS) surveys, which are representative of U.S. state populations, to estimate prevalence and frequency of marijuana use by age.The data are from 39 states that included the module on marijuana use in the past 30 days (n=466,469).We also examine age patterns in use by legalization status and reasons for use of marijuana.Reported marijuana use is much lower among those ages 50 and older (6.49%) than 18-49 (16.3%).Multivariable regression analyses show that marijuana use declines with age (p<.001) and is lower among women (p<.001).Marijuana Self-administered cannabis among older adults demands careful study on their treatment outcomes and consumption patterns, in light of a more accessible, legalized cannabis market.Changing sentiments toward the illicit drug urges new research into its viability as a treatment for conditions in older adults.Ailshire uses the 2018-2021 Behavioral Risk Factor Surveillance System (BRFSS) surveys to compare cannabis use by age group.The data, which is representative of 39 U.S. states, indicate that medical marijuana use increases with age.Furthermore, Kaskie's Cannabis and Older Persons Study (COPS) uncovers the influence of age on cannabis use and motives for consumption.